Provider Demographics
NPI:1548308471
Name:MATTHEWS, JOHN LYLE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LYLE
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 COBBLERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9493
Mailing Address - Country:US
Mailing Address - Phone:919-419-0113
Mailing Address - Fax:919-786-1337
Practice Address - Street 1:3725 NATIONAL DR
Practice Address - Street 2:SUITE 227
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4066
Practice Address - Country:US
Practice Address - Phone:919-786-0055
Practice Address - Fax:919-786-1337
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-013312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225GOtherBCBS
NC891225GMedicaid
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1225GOtherBCBS